Pathogenesis and prevention of necrotizing enterocolitis.

Centre for Reviews and Dissemination, Hull York Medical School, University of York, Heslington, York, UK.
Current Opinion in Infectious Diseases (Impact Factor: 5.03). 03/2011; 24(3):183-9. DOI: 10.1097/QCO.0b013e328345d5b5
Source: PubMed

ABSTRACT Necrotizing enterocolitis (NEC) remains the most common serious acquired gastrointestinal disorder affecting preterm infants. Here we review recent advances in our understanding of the pathogenesis of this multifactorial condition and consider the implications for practice and research.
NEC is an important cause of mortality and serious morbidity in preterm infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. NEC, particularly severe NEC requiring surgical intervention and NEC with invasive infection, is associated with acute morbidity and mortality and adverse neurodevelopmental outcomes. The principal modifiable postnatal risk factors for NEC in preterm infants relate to enteral feeding practices including formula milk feeding, early and rapid advancement of enteral feed volumes, and exposure to H2-receptor antagonists.
Our understanding of the pathogenesis of this condition remains incomplete. With the exception of feeding with human milk, only limited evidence is currently available to support interventions to prevent NEC. Promising strategies that merit further evaluation in randomized controlled trials include the use of prebiotics and probiotics and the avoidance of exposure to H2-receptor antagonists.

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    ABSTRACT: To evaluate the perinatal factors that influence the incidence of necrotizing enterocolitis (NEC) in newborns infants (NBI) weighing less than 1,500 g. A prospective study that analyzed all infants with birth weight (BW) less than 1,500 g born between January 2006 to December 2010 (n=183). They were divided into two groups, i.e. infants diagnosed with NEC (n=18) and infants without a diagnosis of NEC (n=165), which were compared in terms of perinatal factors that could influence the incidence of NEC. Mean data were compared by Student's t-test or nonparametric tests and percentages of categorical variables were compared by the χ² test. When the variables showed differences between groups, they were analyzed using logistic regression with the dependent variable as the presence of NEC. The statistical package used was SPSS 16.0 for Windows. The two groups were similar in terms of most of the clinical and demographic neonatal and maternal data, except for the presence of preeclampsia (PE), which was higher in patients whose children developed NEC (61.1 versus 35,6%). The presence of PE increased the chance of occurrence of NEC by 2.84 times (95%CI 1.0 - 7.7). The only factor that can interfere with the incidence of NEC in infants of very low birth weight was the presence of PE. Awareness of this fact can guide the perinatal team in providing more judicious care regarding the prevention of NEC in this specific population.
    Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 08/2013; 35(8):363-367.
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    ABSTRACT: Necrotizing enterocolitis (NEC) continues to be the most severe gastrointestinal emergency facing the preterm neonate. The pathogenesis of NEC is still a complex and poorly understood process, but with increasing understanding of the role of enteral feeding, gut immunity and the altered gut microbiota, new opportunities to reduce overall NEC rates are now possible. Prevention strategies continue to lead as the most suitable approaches to reducing NEC, as early diagnosis and rapid effective treatment of NEC are still not optimal. Programmatic changes are equally important as subscribing to individual prevention strategies. The primary focus of this review is to summarize the best strategies we currently have to eliminate NEC within an institution.
    Seminars in Fetal and Neonatal Medicine 11/2013; · 3.51 Impact Factor
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    ABSTRACT: Objective Endogenous digoxin-like factor (EDLF) has been linked to vasoconstriction, altered membrane transport, and apoptosis. Our objective was to determine whether increased EDLF in the cord sera of preterm infants was associated with an increased incidence of necrotizing enterocolitis (NEC). Study Design Cord sera from pregnant women enrolled in a randomized trial of MgSO4 for fetal neuroprotection were analyzed for EDLF using a red cell Rb+ uptake assay in which the inhibition of sodium pump-mediated Rb+ transport was used as a functional assay of EDLF. Specimens were assayed blinded to neonatal outcome. Cases (NEC, n = 25) and controls (neonates not developing stage 2 or 3 NEC, n = 24) were matched by study center and gestational age. None of the women had preeclampsia. Cases and controls were compared using the Wilcoxon test for continuous and the Fisher exact test for categorical variables. A conditional logistic regression analysis was used to assess the odds of case vs control by EDLF level. Results Cases and controls were not significantly different for gestational age, race, maternal steroid use, premature rupture of membranes, or MgSO4 treatment. In logistic models adjusted for treatment group, race, premature rupture of membranes, and gestational age, cord sera EDLF was significantly associated with development of NEC (P = .023). Conclusion These data demonstrated an association between cord sera EDLF and NEC.
    American journal of obstetrics and gynecology 01/2013; · 3.28 Impact Factor


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May 24, 2014